CPT for ENT articles are a collaborative effort between the Academy’s team of CPT Advisors, members of the Physician Payment Policy (3P) workgroup, and health policy staff. Articles are developed to address common coding questions received by the health policy team, as well as to clarify coding changes and correct coding principles for frequently reported ENT procedures.

The CMS National Correct Coding Initiative (NCCI) promotes national correct coding methodologies and reduces improper coding which may result in inappropriate payments of Medicare Part B claims and Medicaid claims. The National Correct Coding Initiative (NCCI) contains two types of edits:1. NCCI procedure-to-procedure (PTP) edits that define pairs of Healthcare Common Procedure Coding System (HCPCS) / Current Procedural Terminology (CPT) codes that should not be reported together for a variety of reasons. The purpose of the PTP edits is to prevent improper payments when incorrect code combinations are reported.2. Medically Unlikely Edits (MUEs) define for each HCPCS / CPT code the maximum units of service (UOS) that a provider would report under most circumstances for a single beneficiary on a single date of service.

The Medicare Learning Network® (MLN) Educational Web Guides Documentation Guidelines for Evaluation and Management (E/M) Services offers health care professionals E/M services information and resources. These guides are designed to provide education on evaluation and management services. It includes the following information: medical record documentation, evaluation and management billing and coding considerations. E/M services health care professionals may use either version of the 1995 or 1997 documentation guidelines, not a combination of the two, for a patient encounter.

In order to assist with your reimbursement needs the Academy of Otolaryngology—Head and Neck Surgery has created template letters advocacy statements (otherwise known as blanket statements) to assist members with denials on specific procedures.

The following process is required for a new technology or revised procedure to receive a Current Procedural Terminology (CPT) Code, receive a value, and establish a Medicare payment:

The process begins with review of a Code Change Proposal (CCP) application by the AMA CPT Editorial Panel with involvement of AAO-HNS through the New Technology Pathway Application Process.

After approval by the CPT Editorial Panel, the AAO-HNS is involved in surveying members and making recommendations for a relative value unit (RVU) at a presentation before the AMA/Specialty Society Relative Value Update Committee (RUC).

CMS reviews the RUC recommendations and makes a final decision about the RVU, and a dollar amount is calculated. More information on these steps are provided below.

Overview of AMA CPT Editorial Review ProcessEver wonder how a CPT code is created or an existing code is revised? Would you like to learn more about the literature and other requirements set forth by the AMA in order to obtain approval for a code change proposal (CCP)? Then view these slides prepared by long time CPT Advisor, Past 3P Co-Chair, and AAO-HNS Past-President; Richard W. Waguespack, MD, for a brief and easy to understand guide on the AMA CPT Editorial Panel's process for reviewing CCPs along with literature and other requirements, as well as AAO-HNS involvement in the process.

The AAO-HNS has developed policies and procedures to address requests to create a new code, revise an existing code, or receiving guidance on how to code for new technology. To view a flow chart of the New Technology Pathway process, click here.

Obtaining RVUs for CPT codesImmediately following the CPT Editorial Panel's acceptance of the new code change proposal (CCP), the RUC process begins. All participating specialties have an opportunity to indicate a "level of interest" from which indicates their interest in developing relative value recommendations for the new code(s). All societies have 4 options:

Survey their members to obtain data on the amount of work involved in the services and develop recommendations;

Comment in writing on recommendations developed by other societies;

In the case of editorially changed / revised codes, they could decide that the coding change does not require action because it does not significantly alter the nature of the service or the previously assigned relative value; or

Take no action because the codes are not used by physicians in their specialty.

Detailed information on the Electronic Health Record (EHR), Physician Quality Reporting System (PQRS), Electronic Prescribing (eRx), and Value Based Payment Modifier (VBPM) programs and how you can earn incentives and avoid penalties.

Enhance the business side of your clinical practice by attending the regional workshops conducted by Karen Zupko & Associates. The course sessions, two options on Friday and one on Saturday, are designed to help you with your business and administration skills, ICD-10, and ensure you are coding correctly.

The Academy has published updated fact sheets, available in the May 2014 edition of the Bulletin, to provide information on how you can successfully participate in each of these initiatives, possibly earn incentive payments, and avoid payment reductions.

Position statements are approved by the American Academy of Otolaryngology—Head and Neck Surgery, Inc. or Foundation (AAO-HNS/F) Boards of Directors and are typically generated from AAO-HNS/F committees.